How To Interpret Infant Poop

    Who knew that when your first child arrived, the primary topic of conversation for the foreseeable future would become poop? In our house, we’re either rejoicing over someone pooping on the toilet, lamenting a hard poop that won’t come out, or taking pictures of poopy diapers to ask each other later: “does this look normal to you?” If you are struggling with a constipated child, read about the keys to natural constipation support for kids here. Pregnant or snuggling a newborn? You’re in the right place to learn how to interpret infant poop. 

    The newborn stage is full of wonder. What your child will be like when they grow up. What their first word will be. When (or if!) you’ll ever sleep again. And often, wondering if the latest stuff to exit their little body is normal. Read on for my advice as a pediatric nurse practitioner so you can quit wondering about poop and start learning how to interpret infant poop. Let me help you eliminate added stress during the newborn stage by knowing when not to worry and when to seek additional help. 

    5 Things To Take Note Of When Your Child Poops

    1. Color 

    A baby’s first few poops are called “meconium”, which looks tarry and black. After a day or two, poop should no longer look like this as it gradually lightens to a shade of brown or yellow, depending on how you’re feeding your baby. According to the American Academy of Pediatrics, normal color for infant poop spans yellows, greens, and browns. Breastmilk poop is often a mustard yellow, while formula poop can range from tan or yellow to darker brown. A 2012 study found that 50% of three-month-old babies who were formula-fed had green poop, while the breastfed babies almost always had yellow poop. 

    There are three concerning colors for infant poop. If you notice any of these, be sure to consult your medical provider right away.

    A. Black 
    • Poop should not appear black and tarry again after it has transitioned from meconium. 
    • Blood inside the intestines can turn black by the time it exits the body in poop. 
    • Keep in mind, though, certain foods could also be the culprit. The Cleveland Clinic notes that eating a significant amount of blueberries can turn poop dark blue or even black. 
    B. Red
    • Red in your baby’s poop could indicate blood.
    • The potential causes of blood in a baby’s poop are varied, including milk protein allergy or an infection.
    C. No color (pale, beige, clay, cream-colored)
    • Absence of enough color in your baby’s poop can signify a blockage involving their liver.
    • In particular, pale infant poop can be an indicator of biliary atresia, a rare but serious liver disease. Prompt diagnosis is key to timely and effective treatment.

    A study in the journal Pediatrics found that the use of “stool color screening cards” decreased delayed diagnosis of biliary atresia. The study also reported an increase in both parental and physician cognizance of the disease. An example of an infant stool color card is included below and can be found here. “Stool” is the medical term for poop. 

    How To Interpret Infant Poop

    Visual aids like this card help parents and providers interpret infant poop, communicate effectively, and ultimately save lives. My youngest brother was born with biliary atresia and received a late diagnosis. When his pediatrician asked if his poop was “white,” my mom answered “no” because in her mind it appeared cream-like. This miscommunication delayed further investigation into his symptoms. Thankfully, his eventual surgery was successful despite the delay and today he is a healthy adult. If my brother’s doctor or our mom had access to a stool color card, I’m confident their initial conversation would have gone differently. Equipping families with important tools and information, like a stool color card, is indispensable. 

    2. Consistency 

    The consistency of breastmilk poop is often watery, while babies who drink formula frequently have creamier, thicker poop. If you’re breastfeeding, don’t be surprised if your little one’s poop contains small seeds or granulations. Once solids are introduced, there’s far more variation. You may even see some chunks of undigested food. No cause for concern there! 

    There are two poop consistencies to pay attention to: when the poop is either too hard or too loose. 

    1. Hard pellets
    • Infant poop should not be hard or dry.
    • Sometimes infants become constipated when solids are introduced or major changes in diet occur.
    • Consult your medical provider and read about helpful lifestyle and dietary choices for constipation here
    1. Watery diarrhea
    • It can be tricky to differentiate between diarrhea and normal breastmilk poop, which is normally loose.
    • Seattle Children’s Hospital recommends paying attention to additional factors, such as presence of mucus, blood, or a bad smell, any of which would point to diarrhea.
    • Moreover, check your baby for fever, fussiness, poor eating, or other changes in behavior that could indicate illness.
    3. Frequency

    In a baby’s first few days and weeks of life, you should expect them to poop every day. According to La Leche League, babies usually poop around two to five times per day for the first six weeks of life. A 2012 study found that formula-fed babies poop less frequently than breastfed babies in the first three months. 

    There is significant, normal variation in the frequency of infant poops for both breastfed and formula-fed babies. As you get to know your baby better, pay attention to their habits so you notice when something is out of the ordinary for them. In general, after 6 weeks breastfed babies can keep pooping several times per day, or go as long as two weeks without pooping. This is because a baby’s body can absorb almost all nutrients in the breast milk. According to Seattle Children’s Hospital, if a breastfed baby who is younger than one-month-old is not pooping consistently every day, it might mean they are not getting enough breastmilk. In that case, be sure to reach out to your medical provider. Asking to see a lactation consultant is also very helpful. 

    Consider the color or consistency of the poop if frequency changes. For example, if your baby starts pooping less often, note whether the poop is hard or thicker or if your baby seems uncomfortable. This might suggest constipation. If your baby is formula-fed and has not pooped in five days, you should consult your medical provider. If your baby starts pooping more frequently, notice if the poops have become looser or contain blood or mucus, which would suggest diarrhea. Babies can become dehydrated much faster than adults, so it is important to contact your medical provider if you suspect diarrhea. 

    4. Straining

    While straining in older children is a sign something is awry, it can be perfectly normal in infants, especially those under 4 months old or those not yet eating solid food. Newborns are still learning to coordinate their brain, abdominal muscles, and pooping muscles. As a result, it’s normal for them to grunt and strain with each poop. Use your skills to interpret infant poop: color, consistency, and frequency. As long as the poop is still soft or formed without pellets or balls, your baby’s straining is likely not due to constipation. Check for concerning colors and note how frequently and comfortably your baby is passing poop. 

    5. Smell

    Newborn poop usually does not have any strong smell. Within your baby’s first few weeks of life, good bacteria will start colonizing their gastrointestinal tract. This bacteria is helpful and important, but with it comes more smell! Breastmilk poop generally smells less pungent than formula poop. Some people even describe breastmilk poop as smelling sweet. Once your baby starts eating solids, their poop will become smellier. Moreover, the smells can change in flavor and intensity based on what types of food your baby is eating. 

    Some extra-strong smells are suggestive of infection. One study found that rotavirus could be detected by its distinctive smell in poop. Other times, intense smells in infant poop could be indicative of an allergy or lactose-intolerance. Children’s Wisconsin recommends contacting your pediatrician if your baby’s poop continues to have a strong smell for several days. 

    Interestingly, research has shown that moms prefer the smell of their own baby’s poop to other babies’ poop. Multiple studies produced evidence that mothers were less revolted by the smell of baby poop if it was their child. So maybe let another family member or friend help you interpret infant poop occasionally too! 

    Keeping in mind these five properties when you monitor your baby’s poop can help to distinguish between regular healthy poop and poop that needs medical assistance. If you pay close attention, you’ll be able to evaluate your child’s poop with ease.

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